Massage Therapy for the Scalene Muscles by Paul Ingraham , Vancouver, Canada bio I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about me • more about PainScience.com illustrations by Paul Ingraham, Gary Lyons, Jim Smith, Elizabeth Boylan Trigger points ( TrP s), or muscle knots, are a common cause of stubborn and strange aches and pains, and yet they are under-diagnosed. The 14 Perfect Spots ( jump to list below ) are trigger points that are common and yet fairly easy to massage yourself — the most satisfying and useful places to apply pressure to muscle. For tough cases, see the advanced trigger points treatment guide . Pain Location detail Deep within the Anatomical Bermuda Triangle, a region on the side of the neck, is the cantankerous scalene muscle group. Massage therapists have vanished while working in this mysterious area, never to be seen again.

The region and its muscles are complex and peculiar, and many less-trained massage therapists have low confidence working with them. This article explains how the scalene muscles are involved in several common pain problems in the neck, chest, arm, and upper back, and how to treat pain in these areas by massaging the scalenes. The scalenes are a difficult muscle group to work with, but rewarding! “It’s my hand, doc. My hand hurts.” The scalenes are a strange muscle group If you have stubborn or severe neck pain, you may prefer to start with my advanced neck pain tutorial. The scalenes are often involved in common neck pain and headaches , but that's just the tip of the iceberg. Seriously, this is a weird area: the scalenes often harbour TrPs with more diverse and peculiar symptoms than any other muscle tissue in the body. The primary mechanism for this strangeness is the phenomenon of “referred pain.” Pain in the scalenes is often felt just about anywhere but the scalenes themselves. Instead of your scalenes, your arm or chest might hurt instead.

1 Referred pain effects are par for the course with all muscle pain or any other internal pain — for instance, heart attacks are felt in the shoulder and arm — but the scalene muscles consistently produce unusually complex, variable, and extensive patterns of referred pain. The results can be a bit bizarre, causing symptoms that most people never guess are coming from the scalenes, even doctors and therapists. ZOOM Spreading pain Just like the pain of a heart attack spreads from the heart into the shoulder and arm, the pain of painful scalene muscles spreads throughout the chest, upper back, and chest, the arm and hand, and the side of the head. Pain referred to the back may feel like a penetrating pain stabbing through the torso. And scalene TrPs can also have several other “interesting” (in the sense of the Chinese curse 2 ) effects: on your voice, on swallowing, on emotions, on sensations that sweep through the entire head, the sinuses, hearing, and teeth.

I have found scalene TrPs to be obviously clinically relevant to conditions as seemingly unrelated as: a professional singer with a mysterious degradation of quality in his voice (helped by releasing scalene and other throat trigger points) at least two patients with severe chronic sinus infections that they’d actually had surgery to try to correct (one of them virtually cured by scalene trigger point release alone, the other significantly helped) several people with severe cases of what I call “brick back,” where the space between the shoulder blades feels so stiff and stuck that it’s like there’s a cinder block there instead of bone and muscle cutting off blood and nerve supply to the arm, because tight scalenes can impinge the brachial artery and brachial nerve plexus in the neck the sensation of a lump in the throat in the absence of an actual mass (“globus sensation”) 3 So scalene trigger points are “drama queens,” with symptoms and consequences that seem out of proportion to such small and obscure muscles. They often contribute to anything else that goes wrong in the whole region. Like a gang, scalene TrPs can be counted on to mess up the neighbourhood. The anterior scalene in particular is a trouble-maker, causing and complicating many other problems.

The anatomy of the Anatomical Bermuda Triangle The scalenes fan out from the sides of the neck bones to attach to the ribs, above the collarbone. 4 The scalene group consists of three muscles: the anterior, middle, and posterior scalenes. They generally attach to the sides of the neck vertebrae at the top and to the uppermost ribs at the bottom. So the scalenes are mostly head pullers: they pull the head from side to side. And although they certainly do move the neck, they are also breathing muscles, because of the way they pull up on the ribs. And here’s some more weirdness that makes this muscle group quite interesting: in some people the scalene muscles even reach down between the ribs and attach directly to the top of the lungs, In some people the scalene muscles even reach down between the ribs & attach directly to the top of the lungs. the only muscles that attach directly to the lungs other than the diaphragm. They pull up on the pleura, the membrane that shrink-wraps the lungs. A strange muscle group indeed! Such anatomical variability is actually fairly common throughout our bodies. 5 The scalenes as a group are not hard to find, but they are intricate in their details.

They fill the space between three obvious structures that form the triangle: the collarbone the trapezius muscle on top of your shoulder the long V-shaped throat muscles (sternocleidomastoid or, if that’s too much of a mouthful, just the SCM ) Where is Perfect Spot No. 4 and the scalene muscle group? Perfect Spot 4 is somewhere in the triangle. There is one particular spot, in the belly of the middle scalene, that I think is the most common clinically significant trigger point — the spot most likely to feel important patients — but I don’t want to send you on a wild goose chase trying to locate exactly that spot. Any location within the triangle could prove to be important, so you should definitely explore. Things change, too: Perfect Spot 4 might be in one corner of the triangle one day, and in another corner the next. Precise self-treatment isn’t necessary — a willingness to gently experiment is. The best way to approach this area as a helper is from above the head, with the recipient face up. Without a massage table, it works well to place his or her head in the corner of a bed.

Hold your fingers flat and place the pads of your fingertips in the hollow of the triangle: above the collarbone, in front of the massive trapezius muscle along the top of the shoulder, and on the outside of the prominent V-shaped sternocleidomastoid muscles of the throat. In this position, your hands will be angled inward a bit, and roughly pointing at the sternum. Now press down and perhaps a little inwards with a fairly broad pressure — finger pads, not finger tips — on the ropy muscles that fill the triangle. By using a broad pressure, you can easily stimulate some TrPs and stiff muscle without having to worry about being too accurate. Explore in the triangle with your fingertips, using small circles to find the ropy bands of muscles, gently strumming across them. The area is a rich minefield of trigger points, any of which might be worthwhile and interesting. Danger! If you’re foolish. This area is a little vulnerable, obviously: there is a possibility of impinging blood vessels or nerves. Do not massage this area vigorously, and (for pity’s sake) do not use tools here. Duh.

If you do touch the carotid artery or the jugular vein, the pulse is obvious — just back off. It’s not an appealing place to rub. You no more want to rub your carotid artery than your eyeball. Smaller vessels are not a concern, and nerves are remarkably robust — they tolerate more pressure than most people realize — but it would still be foolish to take chances in this area. Anything else? The trachea and voice box are delicate, but also too central to get in the way of scalene massage, and no one would tolerate any careless pressure there. How should scalene massage feel? Massage feels better on some muscles than others. 6 The scalenes are not really pleasurable to massage, in general. The throat is a vulnerable body part, so many people feel threatened by pressure here — beware of underestimating it, 7 and all the more so if you aren’t confident that massage is safe, or if you don’t understand the strange sensations that are so common in this area. That vulnerability seems to translate into sensitivity, so even a gentle approach may feel a bit hot, nasty, and dodgy at first — not really the kind of trigger point you want to mess around with for fun.

Wow, sign me up! Sounds great, doesn’t it? But it’s not all bad news. Some people enjoy scalene massage right out of the box, and others can come to appreciate it after a period of “working through” and getting used to the uglier sensations. But the best case scenario is when you are actually solving a problem: if your scalenes are in distress and causing a chronic pain problem, then it’s going to feel more like you’re finding the right place to scratch an itch that you couldn’t reach before. Maximize your chances of a positive experience by moving slowly and respectfully, and massaging the scalenes with broader, less “poky” pressure. Such pressure is more likely to produce the best case scenario: a peculiar deep ache spreading into the head, chest, back, and/or arm. At its best, scalene massage feels challenging but “profound.” The spectacular referral patterns make the scalenes feel important, the key to the region. As an entire limb “lights up” with referred pain from a light pressure in the neck, many people will say something like, “Holy $%!@$#$!, what the hell is that?” No muscle produces more amazed comments.

As an entire limb “lights up” with referred pain from a light pressure in the neck, many people will say something like, “Holy $%!@$#$!, what the hell is that?” This is generally true of all referred pain, and it’s equally true of all the Perfect Spots, but “some trigger points are more equal than others.” The scalenes may be awkward and uncomfortable to massage at first, but this Perfect Spot can be very impressive in the end. So be prepared for anything, and take it easy. Although you might have to “work through” a little unpleasant sensation to get to the better sensations, this doesn’t mean “no pain, no gain” — do not be brutal in this area. Patients need a little time to adjust and “accept” the stimulation in this area. Persist respectfully, and there is a fair to middling chance that the sensation will change from hot to warm, from sharper to achier. It might make the transition in five minutes, or it might take a few days of sweet-talking the area. But there is a reasonable limit to how much you should try.

If the effort doesn’t start to develop a bright side after a reasonable amount of time, then this Perfect Spot isn’t so perfect, and you should let it go. Tennis, meet elbow Tennis is the traditional way to get a case of tennis elbow, but it’s not the only way. The respiration connection (theoretical but plausible) Many common aches and pains, particularly around the head, neck and shoulders, may be caused in part by inefficient breathing. It’s just a theory, but the connection between dysfunctional breathing and pain is straightforward in principle: if the diaphragm doesn’t do its job well, muscles in the upper chest (pectoralis minor) and throat (sternocleidomastoid and scalenes) try to take over. Unfortunately, these muscles just aren’t built for routine respiration, and they can exhaust themselves to the point of irritation and injury. A cascade of consequences may result, from garden variety stiffness to seemingly unlikely and severe consequences such as rotator cuff injuries, whiplash and thoracic outlet syndrome — a constellation of painful upper body conditions. And the strange, cranky scalenes are the most likely muscles to cause symptoms in this scenario. For more information, see The Respiration Connection .

The connection If it exists, the connection between dysfunctional breathing and pain is straightforward in principle: if the diaphragm doesn’t do its job well, muscles in the upper chest (pectoralis minor) and throat (sternocleidomastoid and scalenes) try to take over. Unfortunately, these muscles aren’t built for routine respiration, and they exhaust and eventually injure themselves. A cascade of potential consequences results. Anything that makes breathing more difficult could easily provoke over-use of the scalenes. There are many possibilities, but probably the most common and preventable is smoking — which is also risk-factor for chronic pain independently, 8 so it’s a double whammy. This is pure speculation, but smokers could not only have more trigger points in their accessory respiratory muscles, but nastier ones, more painful and persistent. A surprising relationship between the scalenes and tennis elbow This tennis elbow connection is a good example of how odd and clinically relevant the scalenes can be to conditions they don’t seem to have anything to do with at first. The scalene muscle group has surprising importance to a condition called “tennis elbow” or lateral epicondylitis, which commonly afflicts typists as well as racquet sports players.

It is generally characterized as an inflammatory condition, but it is rarely that simple. 9 It is likely that myofascial TrPs, particularly Perfect Spot No. 5 in the muscles of the forearm, play a significant role in any case of tennis elbow. And Perfect Spot No. 4 seems, in turn, to significantly affect Perfect Spot No. 5. Travell and Simons write, “Scalene muscle trigger points are frequently the key to [treatment of] forearm extensor digitorum trigger points.” That is, trigger points on the back of the forearm. 10 So an interesting benefit to treating Perfect Spot No. 4 is that it may be a key to treating Perfect Spot No. 5 ! About Paul Ingraham I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications , or my blog, Writerly . You might run into me on Facebook or Twitter . Appendix A: Is trigger point therapy too good to be true?

Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, that’s a good mix. But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points . Their nature remains somewhat puzzling, and the classic image of a tightly “contracted patch” of muscle tissue may well be wrong. What we do know is that people hurt, and it can often be helped. The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. I’ve written a whole book about it … ZOOM Not too good to be true. Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little, and many will experience significant relief from stubborn aches and pains. The first several sections are free. Appendix B: Quick Reference Guide to the Perfect Spots — Miscellaneous improvements.

Notes This is because our nervous systems generally struggle to isolate where pain is coming from when it’s deeper than the skin. A pinprick on the skin we can locate precisely, but the location of muscle pain often feels out of focus — we just don’t have the neurological “wiring” to get a clear signal. The net effect is sensory confusion. And the confusion seems to be greater with the scalenes than with other muscles. BACK TO TEXT “May you live in interesting times” is one part of a three-part curse that is supposedly “ancient Chinese,” but is probably actually English or American in origin. According to Wikipedia , “The Chinese language origin of the phrase, if it exists, has not been found, making its authenticity doubtful.” The other two parts of the curse are the less famous “may you come to the attention of those in authority” and “may you find what you are looking for.” BACK TO TEXT Globus is the unexplained sensation of a lump in the throat, which is common and often alarming. Although many cases are “all in your head,” many cases probably have subtle physical causes, basically anything that irritates the throat (tonsil stones, acid reflux, Eagle syndrome, cysts, etc).

For more information, see A Lump in My Throat: A globus hystericus story, with a side of science. BACK TO TEXT Yes, you heard me right: ribs! We actually have ribs above our collarbones. The rib cage and lungs are quite “tall,” and this area is the very top of your rib cage. In rare cases, people even have a small extra rib at the top, one vertebrae higher than normal. BACK TO TEXT Learn Muscle Anatomy: Scalene Muscles Learn Muscle Anatomy: Scalene Muscles Tweet If you’re like me, you’ll sometimes toss your head from side to side as you sing loudly in your car (alone, with the windows up, of course—I’m not cruel). This action, in which your neck moves from a straight position to a lateral bend, is called lateral flexion, and a group of muscles called the scalenes (or scalenus muscles) help make it happen. Let’s take a look at them. The scalenes are muscles of the neck, but are also classified as being in the lateral vertebral region. They are responsible for movements of the vertebral column, as well as aiding in respiration.

The muscles in this group are: Posterior tubercles of the transverse processes of C05–C07 Outer surface of the second rib; occasionally blended with scalenus medius Elevates the first and second ribs; bends the spinal column laterally Scalenus medius Posterior tubercles of the transverse processes of C02–C07 Upper surface of the first rib Elevates the first and second ribs; bends the spinal column laterally Scalenus anterior Anterior tubercles of the transverse processes of C03–C06 Scalene tubercle on the inner border and upper surface of the first rib Elevates the first and second ribs; bends the spinal column laterally Muscle Actions of the Scalenes The scalenes are involved in a few actions involving the neck, as well as the act of inhalation. When you move your head from side to side (bending your neck to bring your ear down toward your shoulder) like I do (singing in the car, remember?), this is lateral flexion of the neck.

The other muscles involved are the sternocleidomastoid, splenius capitis, splenius cervicis, longissimus capitis, longissimus cervicis, iliocostalis cervicis, intertransversarii anteriores cervicis, intertransversarii posteriors cervicis, and intertransversarii mediales lumborum. Whew! Watch lateral flexion here: Look straight ahead and then bring your chin down toward your chest. This is neck flexion, and the anterior scalene acts in it. The other muscles involved include the sternocleidomastoid (it’s in everything!), longus capitis, and longus colli. If you look straight ahead, then turn your head to the side, this is contralateral head rotation. The muscles involved include the sternocleidomastoid, rotatores longi, semispinalis capitis, and semispinalis cervicis.

In the act of inhalation (breathing in), the scalenes, along with many other muscles (such as the intercostals), help elevate the ribs, while other muscles, like the diaphragm, help to expand the thoracic cavity. Injury to the Scalenes Since the scalenes are so involved in neck movement and rib elevation, they’re quite easy to injure or become irritated, as they’re working all the time. Whiplash, an injury commonly sustained in car accidents, occurs when your head moves back and then snaps forward (like the crack of a whip), causing distortion of the neck muscles. The scalenes are often strained in cases of whiplash. Rest, ice packs, and limiting movement of the neck will help them heal. The anterior scalene is involved with scalene myofascial pain, which is chronic regional pain that presents with hyperirritable spots called trigger points and a pattern specific to the muscle involved (in this case, the anterior scalene). Scalene myofascial pain is frequently misdiagnosed as another neck pain–associated radiculopathy. Visiting a professional, such as a chiropractor, for treatment, as well as resting and icing the muscle, can help.

Read more about your muscles . Check out our Musculoskeletal eBook Library for free anatomy eBooks. Never miss a thing! Ivan Earl I bought two of your products and was wondering how you orchestrate up-grades and what they cost? Wim Stouwdam Problems with the scalene muscles also occur when your breathing is not in order. Whem you don't use your diaphragm in the right way your scalene muscles take over and they have to do far too heavy a job and you get injuries. Learning to breath healthy again and doing excercises for the scalene muscles will help you get well. Jason C Can explain how to breathe properly? I have horrible referral pain from tight scalènes. Thanks a lot! Wim Stouwdam When you do these exercises gently you will stretch your scalene muscles. But also try another exercise to get your breathingdown to your diaphragm and not with your upperchest. Start breathing in for 5 seconds and hold for 3 sec., then 9 sec. out and for 3 sec. You start using your stomach muscles and eventually your diaphragm.

victor Scalene Muscles - Anatomy Pictures and Information Home > Muscular System > Muscles of the Head and Neck > Scalene Muscles Scalene Muscles The scalene muscles are lateral vertebral muscles that begin at the first and second ribs and pass up into the sides of the neck. There are three of these muscles. (1) The scalenus anterior muscle, which, when the neck is fixed, elevates the first rib to aid in breathing; or when the rib is fixed, bends the neck forward and sideways and rotates it to the opposite side. (2) The scalenus medius is similar to the scalenus anterior and raises the first rib from above or bends to slightly rotate ... The Scalene Trigger Points: Upper Body Troublemakers | TriggerPointTherapist.com Scalene Trigger Points: The Upper Body Troublemakers May 10, 2011 by Dr. Laura Perry Trigger point activity in the Scalene muscle group plays a significant role in many upper body pain complaints.

A therapist must know this muscle group and its trigger points very well if they are to offer effective solutions to their client’s chest pain, upper back pain, shoulder pain, radiating arm pain or thoracic outlet syndrome, wrist pain, and hand pain complaints. The job of releasing Scalene trigger points is made more difficult by the somewhat hidden location of the muscle group and its proximity to many important nerve trunks and blood vessels in the neck region. This combination of factors usually results in many cases of Scalene trigger point activity going undiagnosed and untreated, which creates an opportunity for a good therapist to help the many clients perplexed by this condition. The Scalene Muscles The Scalene muscle group consists of 3 separate muscles: The Anterior Scalene The Middle Scalene The Posterior Scalene All three muscles attach superiorly from the transverse processes of the cervical vertebrae and extend downward to attach to the first and second ribs. Bilateral contraction of the Scalene muscles can elevate the ribs to aid in inhalation, and also flex the neck to the same side if contracting unilaterally.

A neuro-vasular bundle exits the neck region and passes through the space between the middle and anterior scalene muscles, above the first rib and below the clavicle. Scalene Trigger Points, Referred Pain, and Symptoms While each Scalene muscle can harbor multiple trigger points, the primary trigger point in the Anterior Scalene is the most frequently encountered in my clinical experience. My clients with active Scalene trigger points often complain of the following types of pain and symptoms (ordered from most common to least common): A “two-fingered” projection of pain in the chest region pain on the inside border of the shoulder blade pain, numbness or tingling in the thumb or index finger shoulder pain Because these trigger points can cause chest pain and breathing difficulties, many clients become very concerned that they are experiencing cardiac symptoms. Of course, it is critically prudent to refer such clients to a cardiologist for a complete exam, but typically I am referred these patients from a cardiologist after a complete work-up has ruled out any cardiac involvement.

Often these patients are diagnosed with panic attacks, but since Scalene trigger points are activated and perpetuated by hyperventilation-type breathing (upper-chest paradoxical breathing), I find that most of these patient’s panic attacks disappear with the release of active Scalene trigger points. Whiplash from a car accident is also a frequent cause of trigger point activation in this muscle group. Often I see these clients long after their accident, when persistent radiating pain and/or numbness in their arms has them convinced that they suffered a spinal disc herniation or rupture in their neck. Overall, the perplexing nature of the pain and symptoms associated with these trigger points can be quite vexing to a client’s emotional state, and often perpetuates anxiety disorders and depression. Treating the Scalene Trigger Points In teaching the release of Scalene trigger points to therapists over the years, a frequent concern is that most therapists become intimated by these trigger points. Granted, it can be difficult at first to accurately locate and release the Scalene trigger points by palpation, without putting any collateral pressure on the nerve trunks or blood vessels in the immediate region as you do so.

For this reason, I detail a stretch-release technique for the Scalene trigger points in my instructional video: Trigger Point Therapy for the Scalene Muscle Group , that doesn’t require specific pressure on a Scalene trigger point to deactivate it. Still, I have noticed that the really effective therapists make the effort to explore this remarkable muscle group and learn how to release its trigger points safely and reliably. Click on the image below to view an excerpt from the Scalene Trigger Points video on YouTube: Related Myofascial Research and Links: Trigger Point Tips: Scalenes Trigger Point Tips Managing Pain and Enjoying the Journey Saturday, October 22, 2011 Scalenes So, I woke up early this morning and my right hand felt stiff and swollen. It was very painful when I tried to close my fingers into a fist. In fact, I couldn't bend my fingers very much at all. I was still mostly asleep and my mind was trying to remember which muscles I should be checking for swollen fingers. In the meantime, I remembered something helpful. When swollen hands or feet are caused by trigger points (as they often are), it is because some place further upstream, the vessel is being partially blocked or squeezed, preventing the returning fluids from passing through.

So, although I could not remember exactly which muscles to work, I knew that raising my hand higher than the rest of my body would help. So, I stuck my arm straight up in the air for several minutes until the swelling went down a little. Later, when I was conscious, I went to my handy-dandy Trigger Point Therapy Workbook. There was not a category for swollen hands and fingers, so I checked under "hand and finger numbness." Scalenes, subclavius, and pectoralis minor looked like possible candidates, but on p. 140, in the write-up about the pectoralis minor, it said that swelling in the hand and fingers is not a symptom of this muscle, but is caused by "tight scalenes compressing the axillary vein, which runs under the scalenes but not under the pectoralis minor." I decided that the scalenes would be a good place to work. (You can find all the info you want about scalenes on p. 78 of the book if you have it.) Scalenes (pronounced "SKAY-leens) To give you an idea of how influential your scalenes are, on p.

82, it says, "The scalenes are likely to be involved in any myofascial pain problem in the upper body." Here are some examples of possible scalene-related symptoms: Chest pain; upper back pain; restlessness in neck and shoulder; bursitis and tendonitis symptoms; pain, swelling, numbness, tingling, and burning in arm and hand; and, because of the satellite trigger points it creates, headaches. If you grab a hunk of flesh on the side of your neck, you will grab some fairly pliable muscles. If you press into the side of your neck with your fingertips (still holding onto those fleshy muscles), you will press right into the scalenes. The scalenes are much tighter than the outer muscles. Scalene trigger points can be very painful, sometimes feeling like you have hit a nerve. Trigger points can be found anywhere on the scalenes. Work each about six times per session. There are three, sometimes four, bands of scalene muscles. They basically attach your neck bones to your collar bone. Some of the muscles are under the softer, outer muscles, so you need to move them out of the way while you work them.

The scalenes extend from under your ear to your collar bone, and from about 1-2 inches behind your ear down to the collar bone. There is also a horizontal band that is in the triangular depression between your collarbone and the big thick muscle of your upper back (the trapezius). I am thinking that this is probably the one that was causing my swelling. I have found that using supported fingers works well for scalenes. It works better if you have fairly short finger nails. I show just one side of the neck here, but it is a good idea to always work both sides of the body when you are working trigger points. Start just below the ear. The hand underneath (from the opposite side of the body) grabs the outer muscles and pulls them forward. The hand on top pushes on the "tool hand." The tool hand does not push down. The top hand is exerting the force. About six small strokes about one or two seconds each (not too fast) on each trigger point. Note: Any time you do massage, if you feel a pulse, just move over a bit. You should never massage a place where you feel a pulse.

(You would have to go really high up under your chin to get a pulse, and if you are there, you are in the wrong place.) The opposite hand pulls the outer muscles forward. Continue down, moving the outer muscles out of the way. The outer hand exerts the pressure. As you proceed lower, there will be fewer muscles to pull out of the way. Proceed all the way down to the collarbone. There can be some pretty hot trigger points right by the collar bone so don't quit early. Continue with the back scalene, which is located in back of the first. The last scalene actually runs more horizontally, and is located between the bulgy part of your trapezius and your collar bone. The stroke goes from under the trapezius (the big, bulgy muscle in back), parallel to the collar bone, and toward the neck. Written October 5, 2011. Learn Muscle Anatomy: Scalene Muscles and Other Neck Anatomy Learn Muscle Anatomy: Scalene Muscles and Other Neck Anatomy Tweet You know what I love about my neck muscles? EVERYTHING.

They allow me to move my head so I can do all sorts of things, such as look at the Chipotle menu, eat fro-yo, or turn to look at my coworker (who has so thoughtfully just brought me a piece of cake). Okay, basically they let me stuff my face, but the neck muscles do much more than that! The neck muscles (and neck anatomy on the whole) are responsible for head movement, stabilizing the upper region of the body, assisting in swallowing, helping to elevate the rib cage during inhalation, and more. SKELETAL SYSTEM ATTACHMENTS If you press against your neck, you'll feel muscles (obviously). However, the neck region is home to more than just neck muscles; muscles of the head, spine, and thorax also attach in this area. The neck muscles include the scalenes , which attach the cervical vertebrae to the thoracic cage, and the sternocleidomastoid, which attaches the skull to the thoracic cage. These muscles move the head and neck.

There are also muscles that act on the hyoid and laryngeal skeleton (sternohyoid, sternothyroid, thyrohyoid, omohyoid, stylohyoid) and the mandible (mylohyoid and digastric). I mentioned the scalenes above. Let's take a look at them! As always, if you have Muscle Premium , feel free to follow along! SCALENE MUSCLES The scalenes are a series of muscles that work like scaffolding, connecting the cervical vertebrae to the thoracic cage. The scalenes originate on the transverse processes of the cervical vertebrae (C02–C07) and attach to the first and second ribs of the thoracic cage. NECK MUSCLES AND LATERAL FLEXION Watch the scalenes work to support lateral flexion of the neck. NECK PAIN Neck pain can be a, well, real pain in the neck! Neck pain is a very common ailment, and its causes are many—anything from a car accident, to poor posture, to simply sleeping the wrong way. Muscle strains are a common cause.

Overuse of the neck muscles, such as excessive exercise or staying in an uncomfortable position too long (hunched over your computer, for example), can cause strains. Even grinding your teeth at night can do it. Wear and tear on the neck over time can cause pain, including forms of arthritis. Most neck pain responds well to over-the-counter anti-inflammatories, such as Tylenol or Ibuprofen. Rest and alternating heat/cold compresses can help ease pain. Gentle stretching, such as stretching in to the pain, can help alleviate it. Read more about your muscular system . Check out our Musculoskeletal eBook Library for free anatomy eBooks. Never miss a thing! Video: Scalene muscles | Kenhub Scalene muscles Show transcript Hello, everyone! This is Joao from Kenhub, and welcome to another anatomy tutorial where, this time, we’re going to be talking about the scalene muscles. And before I talk about this group of muscles, I need to show you where you can find them. To do so, I’m showing you right now an image of the anterior view of your neck with some of the muscles that you find in this region of your body.

And I’m going to, now, just remove all of these muscles to just expose the group that we’re going to be talking about, which is the scalene muscles. Now, on this tutorial, we’re going to be talking about their anatomy, so we’re going to be talking about their origins, insertions, innervation, functions, as well as some related clinical aspects. And in addition to their kinetic functions on the neck, they are important accessory muscles of inspiration. So it is important to learn and understand how they work. Now, the scalene muscle group contains three muscles that are located at the lateral neck, as you can see here on this image (so, on the sides of your neck). And these are the anterior scalene, the middle scalene, and the posterior scalene. Sometimes, there is a small fourth muscle which is known as the scalene minimus. And generally speaking, the scalene muscles, as you can see here on this image, they run from the vertebrae on the neck and then go all the way to the ribs, and they’re able, when they contract, to lift the thorax.

Let’s start talking about these muscles, and the good news here, in terms of innervation, you only need that all scalene muscles have the same innervation coming from the cervical plexus, seen here highlighted in green from this image, as well as some parts of the brachial plexus. And now, let’s talk about the first scalene muscles that you see here. These are the two anterior scalene muscles (one on each side of your neck). In terms of origin point, they will originate from the anterior tubercle of the transverse processes of C3 all the way to C6 – so, the cervical vertebrae. Then, the muscle is going to run caudally to insert at the first rib, as you can see here on the image. They insert at a tubercle which is known after the muscle as the scalene tubercle of the first rib. A bit further behind, we’re going to find these other two which are known as the middle scalene muscles, and they originate at the posterior tubercles of the transverse processes of C3 all the way to C7, as you can see here on the images.

So the posterior tubercles of the transverse processes of the cervical vertebrae, C3 or third cervical vertebra, all the way to the seventh cervical vertebra. And just like the anterior scalene muscle, the middle scalene runs caudally towards the ribs, as you can see here, to insert on the first rib as well. And it will be inserting dorsally from the subclavian artery and the anterior scalene muscle. And even a bit further posteriorly, we’re going to be finding these two or these pair known as the posterior scalene muscles, which will be originating at the posterior tubercles of the transverse processes of C5 all the way to C7 as you can see here. Now, the muscles progress caudally towards the ribs to insert at the second ribs, as you can see here on the image. We’re now going to move on and talk about the different functions associated to the scalene muscles. We now have here an image of the lateral view of the scalene muscles. And as mentioned before, the scalene muscles have an important function.

So when they contract on both sides, or what we call then bilateral contraction, it will lead to elevation of the first rib, especially when the anterior scalene and the middle scalene muscles will contract, then it will cause elevation of the first rib because if you remember correctly, these two muscles will be inserting on the first rib. And then when they elevate the first rib, the thorax… the rest of the thorax will follow through. So this makes the scalene muscles accessory muscles of inspiration. Now, when there is unilateral contraction (so when one of the muscles is contracting) you’re going to be seeing lateral flexion of the cervical spine – so movements side to side as you see here indicated by this arrows. And furthermore, a bilateral contraction of the anterior scalene muscle causes bending of the cervical spine to the front to what we call, then, ventral flexion, seen here indicated by this arrow. And here’s a tip on how to understand the functions or actions of these muscles. You can compare the inspirational function of the scalene muscles to the departure of a train. The front locomotive or the scalene muscles will be pulling the first wagon, which is then this here, the first rib.

Then, the rest of the ribs, being the other wagons of the train, as you can also see here on this image. And when the first rib is pulled up, the intercostal muscles between the ribs—like I mentioned before, there are all these connections happening between these ribs—now, these connections will help tense and also pull the rest of the train wagons (a.k.a. ribs) along with them until the whole train or the thorax moves or elevates. Now that we covered the different origins, insertions, and functions, and even innervation related to the different scalene muscles, I would like to add an important point that is also related and usually mentioned whenever we talk about the scalene muscles. As you can see here, there’s an important structure being formed by the scalene muscles, an important structure where other important structures will be passing through. So notice here, this is the anterior scalene muscle, which is forming with the middle scalene muscle and also the first rib, a triangle which is known as the interscalene triangle, and I’m highlighting it right now on the screen.

Now, this is an important structure because, here, the subclavian artery, as you can see here, and the brachial plexus will be passing through this triangle, or it will be passing… these structures will be passing through a gap that is formed by these muscles. I would like to add a very important point here, because this is usually an exam question (so write this on your notes) that the subclavian vein does not run through the interscalene triangle, and I just added the two subclavian veins on each side, and you notice here how it’s running in front of the anterior scalene muscles. So the subclavian veins are going to be running between the anterior scalene muscles and these muscles that I’m adding right now, the sternocleidomastoid muscles. Before I end this tutorial, I would like to add some clinical anatomy points. One of them is related to the previous structure that I just talked about. So when the interscalene triangle is too narrow, it will be compressing these structures that pass through it which are the brachial plexus and the subclavian artery if you remember correctly.

When that happens, we call it the scalene syndrome or thoracic outlet syndrome. However, the thoracic outlet syndrome can have other causes other than those related to the interscalene triangle. Now, in terms of the different causes for the scalene syndrome, maybe, amongst others, a hypertrophy of the scalene muscles due to chronic overload or variations or deformities of the first rib. Now, back to the clinical points, I would like to also add that compression of the brachial plexus will lead to paresthesia, or tingling, or tickling, prickling—this is what we call, then paresthesia—and also pain. Whereas the compression of the subclavian artery can lead to circulatory disorders, such as edema or ischemia. Continue your learning Working With The Scalenes || Massage Therapy Articles Working With The Scalenes myofascial techniques By Til Luchau Originally published in Massage Bodywork magazine, January/February 2011. Copyright 2011. Associated Bodywork and Massage Professionals . All rights reserved. It is the scalanes' slanting, inclined, and tilted orientation that gives rise to their name.

Scalene is a transliteration from Greek, meaning "skew": neither parallel nor perpendicular. This angled arrangement, in addition to making the scalenes powerful side-benders and rotators of the neck, puts them in position to align and stabilize the upright cervical column, much as would the angled rigging of a ship's mast (Image 2). At least, that's how the scalenes function when they're balanced. When they're shorter or tighter on one side, their angled left/right and anterior/posterior arrangement can cause them to literally "skew" the neck and upper ribs. This means that scalenes are involved in these postural and positional issues: - Torticollis (wry neck) is a persistent and often painful torsion of the neck, typically accompanied by asymmetrical scalene spasm and rigidity. - In both head-forward postures, as well as the "dowager's hump" pattern, the anterior scalenes are often hard, tight, and short, pulling the lower cervical vertebra forward into a rigidly flexed position (Image 3).

- Although usually considered cervical flexors, once the neck is extended (as in the cervical lordosis that often accompanies a head-forward position), the scalenes can become cervical extensors. This change in function is a result of both their upper and lower attachments now being posterior to the articulations they affect, making it impossible for the scalenes to counterbalance the lack of length in the posterior neck (Image 4). Shortness in the scalenes will thus perpetuate and reinforce the cervical lordosis. The scalenes are involved in other conditions as well: - Scalenes are often injured in whiplash injuries, especially when lateral forces are involved. (Although working the scalenes can dramatically aid recovery from whiplash, massage is most appropriate with "cold" whiplash--fixed, chronic, older injuries. Direct work on the scalenes can aggravate whiplash symptoms when applied too soon after an injury, too aggressively, or in the presence of "hot" whiplash signs (muscular spasm, autonomic activation, instability, or guarding).1 - Because the scalenes also aid in forced inspiration by lifting the first two ribs, they are often chronically shortened when there are respiratory issues, such as asthma.

- The scalenes stabilize the base of the neck against the asymmetrical forces of being right- or left-handed. For this reason, people who habitually use their dominant hand to apply force (such as manual therapists), will have scalenes that are often significantly tighter on the side opposite the dominant hand. - The deep pleural ligaments (Image 5: transversopleural, vertebropleural, and not pictured, costopleural) are fibrous bands that anchor the endothoracic fascia around the lungs to C7, T1, and the first rib. Lying deep to the scalenes and roughly parallel to their oblique arrangement, the pleural ligaments can have effects similar to the scalenes on the alignment and mobility of the base of the neck. - Because the nerves of the brachial plexus pass between the anterior and the medial scalenes, crowding here can exacerbate symptoms of neurovascular compression (such as thoracic outlet syndrome).

Working the scalenes is indicated when there is numbness or tingling in the ulnar nerve distribution area (the small and ring fingers and medial hand, Image 7), especially when symptoms worsen with forced inhalation (which engages the scalenes) or neck rotation (which scissors the brachial plexus between the anterior and medial scalenes, Image 6). Anterior Scalene Technique These are all good reasons to include scalenes whenever you address the neck. However, working them directly can be tricky. The scalenes are often more contracted and denser than the tissues around them. (Researcher V. Janda classifies the scalenes as "tonic" muscles, meaning that when stressed they are prone to tightness rather than weakness, which may explain why they're so often contracted.)2 The scalenes also lie close to the sensitive nerves of the brachial plexus (Image 5). This combination of hardness and proximity to nerves makes it difficult to use any degree of pressure or sliding without causing referred nerve pain. However, if we avoid sliding on them, and first slacken the scalenes by approximating their attachments, we can address them more comfortably and at much deeper levels.

To accomplish this, begin by cradling your client's head in one hand (Image 8). With the other hand, use the broad touch of several finger pads together to feel for the hard, longitudinally angled bellies of the anterior and medial scalenes, just above the clavicle and deep to the sternocleidomastoid. The hardest structure you feel here that isn't bone is usually the anterior scalene. Now lift the head, gently flexing the neck around the static fulcrum of your other hand. You'll feel the bellies of the scalenes press against your finger pads as you do this; apply just enough posterior pressure to resist the anterior movement of the scalenes and lower cervicals. This combination of vectors bends the anterior scalenes around your fulcrum hand and encourages the cervicals to drop posteriorly, reducing their tendency toward anteriority (Image 9). If this feels "nervy" to your client, or especially if he or she feels tingling in the fingers or hands when you apply pressure, reposition your touch so that it is comfortable, usually by shifting slightly medially.

Shift too far medially or too high, though, and you'll be near the carotid artery, jugular vein, or vagus nerve--none of which like direct pressure. Keep your touch broad, soft, and sensitive. It should never be uncomfortable to your client. Once you have the counterforces of flexion and posterior pressure comfortably in place, resist the temptation to slide, nudge, or otherwise move your fingers on the delicate scalenes. Instead, wait for the body to respond. After three to six breaths, you'll typically feel the scalenes and lower cervicals ease and drop posteriorly as the tissues soften and the nervous system adapts. This is the sign that it's OK to move to a new position. By releasing and moving your fulcrum position (rather than by sliding), you can then work higher or lower parts of the scalenes. Feel for left/right asymmetries in the scalenes, and in the deeper plural ligaments (Image 5) once the scalenes' tone is reduced. Alternatively, you can shift your fulcrum slightly lateral, adding a bit of cervical sidebending around your finger pads to access the medial and posterior scalenes (Image 10).

Wait for release and softening in each place. Stay in verbal contact with your client about any referred nerve pain. Be patient; wait for the release. Of course, you'll want to work the scalenes only after you've done other preparatory work to warm up the outer layers of the neck, and to accustom your client to your touch. Before you finish, be sure to work the scalenes on both sides; if you find asymmetrical patterns, the amount of time you spend on each side will be different. Finish your scalene work with integrative, balancing, soothing techniques; even if you avoided pressing directly on the nerves of the brachial plexus, working the tonic scalenes can be sympathetically activating rather than parasympathetically calming. "Mother Cat" Technique In addition to the scalene work discussed, a technique we call the "Mother Cat" is meant to calm the tissues of the neck. You've seen what happens when a mother cat picks up her kitten by the scruff of its neck--the kitten goes limp. This reflex is the source of the name we've given this technique, since humans also seem to let go, relax, and surrender with posterior traction on their neck fascia.

Like a kitten being carried by its mother, people relax when their cervical fascias are eased. To perform the Mother Cat technique, wrap a soft hand around the back of your supine client's neck, encompassing as much of both sides as possible. With the palm and fingers of your full hand, grasp and gather the outer layers of the nape of the neck straight backward toward the posterior midline (that is, toward the floor), applying gentle posterior traction to the outer layers of superficial fascia and trapezius. Allow the tissue layers to slowly slide out from under your hands a bit. Repeat several times, switching hands if you wish. Although we're working both sides of the neck at the same time, the different shape of the left and right hands will allow you to access different aspects with each. Our aim is to both ease the outer tissues of the neck and to shift the autonomic tone of our client's nervous system. Accordingly, let your pace be slow, steady, and patient as you repeat this technique, feeling for both tissue restrictions and for your client's parasympathetic relaxation response.

Although this technique's calming effects make it an ideal follow-up to the scalene work described earlier, these same properties make it an effective way to prepare a client for deep work as well. I originally learned this technique from William "Dub" Leigh, who called it "milking the neck," a name which hints at the repetitive, hypnotic motion that gives it its effectiveness. Dub, in turn, said he learned it from the legendary body therapy pioneer Moshe Feldenkrais, who (according to Dub) would patiently "milk the neck" for the first 10 minutes of his hands-on Functional Integration sessions. Feldenkrais, a scrappy Ukrainian-Israeli physicist and Judo champion (who, incidentally, taught Israeli Prime Minister Ben-Gurion how to stand on his head), reportedly claimed that with just this technique and enough time, he "could have any man eating" out of his hand. If you're inclined to try this experiment, do let me know the results, but please remember, along with great power, comes great responsibility. Til Luchau is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad.

He is also a Certified Advanced Rolfer and teaches for the Rolf Institute. Contact him via info@advanced-trainings.com and Advanced-Trainings.com's Facebook page. Notes 1. For more on "hot" and "cold" whiplash, see "Myofascial Techniques: Working with Whiplash, Part 1," Massage Bodywork, March/April 2010, page 108; "Myofascial Techniques: Working with Whiplash, Part 2," Massage Bodywork, May/June 2010, page 108. 2. V. Janda, "Muscles and Cervicogenic Pain Syndromes," in Physical Therapy of the Cervical and Thoracic Spine, ed. Ruth Grant (New York: Churchill Livingstone, 1988). Sidebars:

Question: Where in the body would you find the Scalens muscles?
Answer: The Neck